Mason Pointe Care Center
13190 South Outer 40 Road, Chesterfield, MO 63017 · Non profit - Corporation · 63 certified beds · (417) 932-8040 Medicare & Medicaid certified
On the public record, this home looks stronger than most — but visit before you decide.
- a strong health-inspection score (5/5) — the hardest rating to game (though it’s ranked within its own state, not nationally)
- no federal fines or payment denials on record
- a high payroll-based staffing rating (4/5)
- it has a citation for its abuse-prevention policies, restraint use, or reporting and investigating of allegations (F0609) — cited below the harm level, meaning inspectors found the process wanting but did not find a resident harmed
- a high number of inspection citations overall (17) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
- its last standard health inspection was over 2 years ago — the star rating may not reflect current conditions
One thing this read cannot see: what residents and families actually experience day to day. Public data misses the feel of a place — visit unannounced, ideally at a mealtime or on a weekend, talk to staff and families, and ask your tour questions.
A plain-English summary of the public record below — not a rating, ranking, or recommendation. We take no money from any facility.
| Health inspectionSurveyor-assigned, ranked within your stateInspector-verified | 5 of 5 |
| StaffingFrom payroll records (PBJ) | 4 of 5 |
| Quality measuresSelf-reported by the facility | 5 of 5 |
Location & what’s nearby
Open in Google Maps ↗ · Directions ↗ · Larger map ↗
Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.
Quality measures — how residents actually fare
| Overall quality measures | 5 of 5 |
| Long-stay residentspeople who live here | 5 of 5 |
| Short-stay residentsrehab / post-hospital | 5 of 5 |
Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.
Trend — is this home getting better or worse?
Over 2025-02 to 2026-06, this home’s CMS overall rating held steady at 5 stars. From monthly CMS archive snapshots.
Horizontal axis runs 2025-02 to 2026-06. That is where CMS’s monthly archive ends, so the right-hand edge of each line is that month — not today.
See all quality measures vs. state & national benchmarks
| Measure | This home | State avg | Typical state | vs typical state |
|---|---|---|---|---|
| Long-stay residents whose need for help with daily activities increased | 10.6% | 18.1% | 15.4% | better |
| Long-stay residents who lose too much weight | 1.6% | 5.3% | 5.4% | better |
| Long-stay residents with a catheter left in their bladder | 0.0% | 1.1% | 0.9% | better |
| Long-stay residents with a urinary tract infection | 1.3% | 2.3% | 2.0% | better |
| Long-stay residents with depressive symptoms | 0.8% | 18.5% | 6.5% | better than state‡ — see note marked double-dagger below the table |
| Long-stay residents who were physically restrained | 0.0% | 0.0% | 0.1% | better than state‡ — see note marked double-dagger below the table |
| Long-stay residents with falls causing major injury | 0.7% | 4.1% | 3.3% | better |
| Long-stay residents whose ability to walk worsened | 13.2% | 17.4% | 16.1% | better |
| Long-stay residents on antianxiety or hypnotic medication | 24.4% | 25.6% | 18.9% | worse |
| Long-stay residents given the seasonal flu vaccine | 97.0% | 90.9% | 95.3% | typical |
| Long-stay residents with pressure ulcers | 2.4% | 4.5% | 4.7% | better |
| Long-stay residents with worsening bladder/bowel control | 10.1% | 17.8% | 21.2% | better |
| Long-stay residents who got an antipsychotic medication§ — see the note below the table | 12.2% | 23.5% | 17.1% | better |
| Short-stay residents who newly got an antipsychotic medication | 0.0% | 2.2% | 1.4% | better |
| Short-stay residents given the seasonal flu vaccine | 90.5% | 63.5% | 79.4% | better |
| Short-stay residents rehospitalized after admission | 13.4% | 26.0% | 22.6% | better |
| Short-stay residents with an outpatient ER visit | 0.0% | 13.7% | 12.0% | check this* — see note marked star below the table |
| Long-stay hospitalizations per 1,000 resident days | 2.03 | 2.11 | 1.67 | worse |
| Long-stay outpatient ER visits per 1,000 resident days | 0.96 | 2.33 | 1.80 | better |
* This home reported 0% on a measure where lower is better. That can mean genuinely excellent care — but because the number is self-reported, a zero can also mean the problem was not recorded. Weigh it against the inspection record above.
‡ On this measure the state average is at least twice (or half) the typical state — a gap that size is usually how the state codes and reports the measure, not how its homes actually perform. Against a benchmark this state does not sit on, a “vs typical state” verdict would mostly be measuring the state, so we compare this home with its own state instead and show both averages.
§ Antipsychotics carry an FDA boxed warning — they raise the risk of death in older people with dementia-related psychosis, and are not approved for that use. So this measure is partly a read on whether a home sedates residents instead of staffing for them. But read a low rate carefully in both directions: CMS excludes residents coded with schizophrenia (and Tourette's or Huntington's) from this measure, and federal auditors have found implausible increases in schizophrenia coding since the measure was published — so a very low rate can reflect recoding rather than less prescribing. Ask the home what share of its residents carry a schizophrenia diagnosis, and how it handles behavioral symptoms without medication.
CMS quality measures, as Care Compare shows them. For most rows lower is better (fewer falls, ulcers, hospitalizations); vaccination rates are the exception. Not every row is risk-adjusted. CMS adjusts some measures for resident mix, but falls with major injury, antipsychotic use, physical restraints and the vaccination rates are unadjusted rates — so a home caring for heavier or more behaviorally complex residents can look worse on them without providing worse care. The “typical state” column is the median of the 50 state averages — not a national average of all homes. We use it because a plain average across homes is pulled badly off course by a few states’ reporting habits (long-stay depressive symptoms is the clearest case: Illinois codes it several times higher than most states, which alone lifted the all-homes figure to about twice what a typical state records). The median of state averages resists that — but it does weigh every state equally, so a large state counts no more than a small one, and it is a benchmark of our construction rather than a CMS-published figure. better/worse means the home differs from that benchmark by more than 10% of it; closer than that reads typical. CMS does not publish how many residents each measure covers, and the counts are often small — a single resident can move a rate by several points — so treat small gaps as noise. These come from data the facility reports, so weigh them against the independent inspection record above.
Short-stay rehab — if you are coming here from a hospital
Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.
42.8% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — which CMS reads as no different from the national rate. This is CMS’s risk-adjusted rate over 37 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.
Met the expected recovery: 31.4% of this home’s Medicare short-stay residents left it at or above the ability to care for themselves and move around that CMS predicted for them, across 35 stays in Oct 2024–Sep 2025. The median of the 11,061 homes CMS publishes this for is 56.6%. Read it beside the getting-home figure, not instead of it: unlike the two measures above, CMS makes no better-or-worse call on this one and publishes no confidence interval for it, so this is a comparison and not a verdict — but it is the short-stay measure that separates homes most, and the one to ask about.
Therapy staffing: not reported. This home filed no therapist hours at all in its payroll data for this quarter. That is a gap in what it reported, and we do not read it as an absence of therapy — the homes that file nothing here include ones that discharged hundreds of Medicare rehab patients in the very same period, who plainly received therapy from someone. Because we cannot tell a home that under-reports from one that genuinely provides little, this home is left out of the comparison above rather than scored at zero. Ask it directly how many therapist hours a rehab resident gets, and on which days.
This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.
See every short-stay measure CMS publishes for this home
| Measure | This home | U.S. median | Period covered | CMS’s call |
|---|---|---|---|---|
| Got home and stayed homeRate of successful return to home or community from a SNF | 42.8%CMS range 32.6–56.0 | 51.5% | Oct 2022–Sep 2024 | no different from U.S. |
| Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF | 12.0%CMS range 8.4–18.0 | 10.7% | Oct 2022–Sep 2024 | no different from U.S. |
| Met the expected recoveryPercentage of residents who are at or above an expected ability to care for themselves and move around at discharge | 31.4% | 56.6% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Self-care at dischargePercentage of residents who are at or above an expected ability to care for themselves at discharge | 34.3% | 52.8% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Moving around at dischargePercentage of residents who are at or above an expected ability to move around at discharge | 20.0% | 50.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Medication problems followed upPercentage of residents whose medications were reviewed and who received follow-up care when medication issues were identified | 100.0% | 98.7% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Medication list to the next providerPercentage of residents where the SNF provided a current medication list to the next health care setting | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Medication list to the familyPercentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge | 100.0% | 98.7% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Falls with major injuryPercentage of SNF residents who experience one or more falls with major injury during their SNF stay | 0.0% | 0.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| New or worsened pressure ulcersPercentage of residents with pressure ulcers/pressure injuries that are new or worsened | 0.0% | 1.9% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Infections that led to hospitalPercentage of infections residents got during their SNF stay that resulted in hospitalization | 6.8%CMS range 3.2–13.1 | 7.1% | Oct 2023–Sep 2024 | no different from U.S. |
| Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs | 0.83 | 1.02 | Oct 2022–Sep 2024 | CMS makes no comparison for this measure |
From the CMS Skilled Nursing Facility Quality Reporting Program — Medicare short-stay outcomes, which is a different dataset from the long-stay quality measures above and describes a different set of residents. Where CMS risk-adjusts a measure we show its adjusted rate, and the CMS range beside it is the confidence interval CMS publishes: a home whose range is wide is a home with few stays, where one patient moves the number several points. Read the period column. These measures do not share a window — the claims-based ones (getting home, readmission, spending) lag by a year or more, because a stay has to finish and its claims settle before it can be counted. CMS’s call is CMS’s, not ours: it is the only place anyone tests whether this home differs from the national rate at all, and most homes on most measures do not. Two caveats on it. CMS tests only three of these measures — getting home, readmission, and infections that led to hospital; on the other nine it publishes a rate and no comparison, and rather than compute a verdict CMS declined to make, we say so in the column. And on readmission almost every home in the country lands on “no different”, so that row separates homes far less than getting-home does — which is why met the expected recovery, a measure CMS does not test but which spreads across the whole range, is called out above the table rather than left in this list. The U.S. median column is our own, taken across every home CMS publishes that measure for in this same file; it is not a CMS-published benchmark. Homes CMS gives no rate for are left out of it rather than counted as zero. Medicare spending per stay is a ratio, not a percentage — 1.00 means this home’s Medicare spending for a stay matched the national figure CMS compares it against, and it measures cost to Medicare, not quality of care.
Staffing
How full it usually is: this home is certified for 63 beds and averages 37.5 residents a day — about 60% occupied, or roughly 26 beds typically open. It often has substantial empty capacity — worth asking why, since low census can reflect either a new or shrinking home or one families are avoiding. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.
Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 4.32 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 0.88 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 2.64 is at or above the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.
Weekend coverage: total nurse staffing is 3.75 hrs/resident/day on weekends vs 4.55 on weekdays — 18% thinner on weekends. RN hours go from 1.07 to 0.43 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)
This home’s total nursing-staff turnover of 40% is about the same as the national median of 45%. 1 administrator has left in the past year.
Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.
Inspection trend
Deficiencies are more than at the previous inspection — worsening. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.
This trend is not current. The most recent of these two inspections was over 2 years ago; the arrow describes what inspectors found then, not what the home is like now.
Inspection deficiencies
State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.
Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.
17 citations, most serious first. The 10 most serious are shown; the remaining 7 are one tap away and print in full.
- Potential for harm · Dcited before2024-08-22 · tag F0761 — failed to label and store drugs safely — isolatedEnsure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, and review of facility policy, the facility failed to ensure that 1.) one of two treatment carts (A3 skilled unit) was locked and secured. This failure created the risk of unauthorized access to medications and supplies by residents and staff, and 2.) failed to ensure expired medical supplies; including urinary catheters, intravenous (IV) catheters, and syringes; were removed from one of two medication rooms (M3 skilled unit). This failure created the risk of less effective medical supplies being used for residents. Findings include: 1. Review of R169's Face Sheet, located in the resident's electronic medical records (EMR) under the Admissions tab, indicated the resident was admitted to the facility on [DATE] with diagnoses that included Alzheimer's Disease, dementia, and manic-depressive disorder. Review of R169's annual Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 08/06/24 and located in the resident's EMR under the MDS Assessments tab,…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · E2019-06-11 · tag F0625 — patternNotify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on interview and record review, the facility failed to provide written notice to the resident or their legal representative of the facility bed hold policy at the time of transfer to the hospital for five of 28 sampled residents, who were recently transferred to the hospital for various medical reasons (Residents #67, #27, #138, #66 and #90). The census was 205 with 140 residents in certified beds. 1. Review of Resident #67's electronic medical record, showed: -Discharge to the hospital on 3/29/19; -Returned to the facility on 4/2/19; -No documentation the resident and/or the representative received written notice of the facility's bed hold policy at the time of transfer. 2. Review of Resident #27's electronic medical record, showed: -discharged to the hospital on 2/25/19; -Returned to the facility from the hospital on 3/4/19; -discharged to the hospital on 3/6/19; -Returned to the facility from the hospital on 3/11/19; -No documentation the resident and/or the representative received written notice of the facility's bed hold policy at the time of transfers. 3. Review of…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · E2019-06-11 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — patternEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to ensure the resident environment remained as free of accident hazards as is possible and each resident receives adequate assistive devices to prevent accidents by failing to ensure a resident's electronic wheelchair had been charged and was available for use during transport to a scheduled appointment. The resident had a history of slipping out of the chair used in place of the electric wheelchair and this resulted in a fall during transportation. In addition, the facility failed to follow the safe medication storage policy when medications were left accessible, on top of a medication cart and in an unlocked nurse cart. These practices affected one of 28 sampled residents (Resident #66) and had the potential to affect all residents who could self-ambulate or self-propel on the halls where the medications were left accessible. The census was 205 with 140 residents in certified beds. 1. Review of the facility's Fall Policy, dated [DATE] and…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2019-06-11 · tag F0554 — isolatedAllow residents to self-administer drugs if determined clinically appropriate.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, interview and record review, the facility failed to ensure the resident's right to self-administer medications is supported, only if the interdisciplinary team has determined that this practice is clinically appropriate, for two residents observed to self-administer medications (Residents #45 and #11). The census was 205 with 140 in certified beds. Review of the facility's Policy and Procedure for Administering Medication, dated 1/25/17, and reviewed on 9/25/18, showed: -Policy Statement: Medication shall be administered in a safe and timely manner and as prescribed. The community shall provide residents with necessary medication(s) when they leave the community temporarily; -Residents may self-administer their own medications only if the physician, in conjunction with the Interdisciplinary Care Planning Team, has determined that the resident has the decision-making capacity to do so safely. 1. Review of Resident #45's electronic physician order sheet (ePOS), showed: -Diagnoses included High blood pressure, heart disease, chronic kidney disease and…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2019-06-11 · tag F0577 — isolatedAllow residents to easily view the nursing home's survey results and communicate with advocate agencies.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation and interview, the facility failed to maintain all survey reports, certifications and complaint investigations made during the three preceding years and any plan of correction in effect with respect to the facility. The census was 205 with 140 residents in certified beds. Observations on 6/5/19 at 8:10 A.M., on 6/6/19 at 6:30 A.M., on 6/7/19 at 1:00 P.M., on 6/10/19 at 11:42 A.M. and on 6/11/19 at 1:40 P.M., showed a sign posted at the front entrance of the Arborview building, Facility state survey results are available for viewing. A binder containing results is located at the Arborview reception desk. Observation of the Arborview reception desk, showed no state survey results binder available for viewing. During an interview on 6/10/19 at 11:42 A.M., when questioned about the state survey results binder, Receptionist A walked back into another office behind the reception desk, brought out the binder and said the binder is always kept in the room behind the reception desk and visitors, residents and staff would have to ask the receptionist to see the binder.…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2019-06-11 · tag F0609 — failed to report abuse allegations — isolatedTimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to follow their policy for abuse and neglect by failing to report an incident of potential resident to resident abuse to the State Survey Agency when a resident slapped another resident (Residents #14 and #62). The census was 205 with 140 residents in certified beds. Review of the Centers for Medicare and Medicaid services (CMS) State Operations Provider Certification, showed §483.12 Freedom from Abuse, Neglect, and Exploitation: -The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation; -Definitions: Abuse, is defined as the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish; -Guidance: Resident to Resident Abuse of Any Type: A resident to resident altercation should be reviewed as a potential situation of abuse. Having a mental disorder or cognitive impairment does not automatically preclude a resident from…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2019-06-11 · tag F0658 — failed to meet professional standards of care — isolatedEnsure services provided by the nursing facility meet professional standards of quality.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to ensure services provided met professional standards of practice by failing to provide weight parameters for daily ordered weights, notify the physician when a weight increase occurred and provide appropriate diagnoses with the use of antibiotic administration. This affected two of 28 sampled residents (Residents #142 and #344). The census was 205 with 140 residents in certified beds. 1. Review of Resident #142's medical record, showed: -admitted to the facility on [DATE]; -Diagnoses of heart failure, vascular disease and kidney disease; -Extensive assistance required for transfers and personal hygiene. Review of the resident's admission electronic physician order sheet (ePOS), showed an order dated 5/21/19, for daily weights in the early morning. The order did not include weight parameters for when to contact the physician. Review of the resident's care plan, in use at the time of the survey and reviewed on 6/6/19, showed the care plan did…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2019-06-11 · tag F0686 — failed to prevent and treat pressure sores (bedsores) — isolatedProvide appropriate pressure ulcer care and prevent new ulcers from developing.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to ensure residents with pressure ulcers (injury to the skin and/or underlying tissue as a result of pressure or friction) or are at risk for the development of pressure ulcers received the necessary treatment and services, consistent with professional standards of practice, to promote healing and prevent new ulcers from developing for two of two sampled residents with specialty mattresses on their beds (Residents #3 and #2). The census was 205 with 140 residents in certified beds. 1. Review of Resident #3's quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 3/7/19, showed: -Diagnoses included Alzheimer's disease, chronic obstructive pulmonary disease (COPD, lung disease), osteoarthritis and a history of a Stage III pressure ulcer (full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle is not exposed. Slough may be present but does not obscure the…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2019-06-11 · tag F0690 — failed to manage incontinence, catheters, and urinary infections — isolatedProvide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to ensure appropriate treatment and services for residents who used indwelling urinary catheters by failing to ensure residents had complete physician orders for the catheter use to include catheter size, balloon size and diagnoses. The facility also failed to ensure appropriate catheter drainage bag positioning and ensure the urinary drainage bag remained covered. This affected four of five facility identified residents that used indwelling urinary catheters (Residents #66, #138, #142 and #90). The census was 205 with 140 residents in certified beds. Review of the facility's urinary catheter (a tube placed into the bladder to drain urine) care policy, revised on 11/19/18, showed: -Purpose: To prevent catheter associated urinary tract infections (UTIs); -Maintaining unobstructed urine flow: Check the resident frequently to make sure they are not lying on the tubing and to keep the catheter and tubing free of kinks. The urinary drainage bag…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2019-06-11 · tag F0695 — failed to provide proper breathing / tracheostomy care — isolatedProvide safe and appropriate respiratory care for a resident when needed.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to provide oxygen therapy consistent with professional standards of practice for three of four residents investigated for respiratory care, who received oxygen therapy (Residents #3, #65 and #23). The sample was 28. The census was 205 with 140 residents in certified beds. Review of the facility's policy for Oxygen Administration, dated 12/10/17 and revised on 7/23/18, showed: -Oxygen humidifier bottle and tubing should be changed monthly; -Oxygen tubing should be stored in a plastic bag when not in use. 1. Review of Resident #3's quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 3/7/19, showed: -Diagnoses included chronic obstructive pulmonary disease (COPD, lung disease); -Received oxygen therapy. Review of the resident's electronic physician order sheet (ePOS), showed an order dated 1/15/18, to administer oxygen at 2 liters (L) per minute by nasal cannula (NC) for oxygen…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
Show the remaining 7 citations
- Potential for harm · D2019-06-11 · tag F0725 — failed to have enough nursing staff — isolatedProvide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to assure the facility provided services in sufficient numbers of each of the following types of personnel on a 24-hour basis to provide nursing care to all residents in accordance with resident care plans: Licensed nurses and other nursing personnel, including but not limited to nurse aides, by failing to assure facility staff were assigned to and provided care for three of three spine or orthopedic surgery center residents followed by a contracted spine and orthopedic surgery center for post-surgical care (Residents #244, #245 and #246). The contract between the surgical center and facility specified that the clinic staff would provide services related to intravenous medication administrations. The agreement did not specify that any other direct resident care or services were to be provided to the resident by the surgical center. The sample was 28. The census was 205 with 140 residents in certified beds. Review of the facility's Clinical…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2019-06-11 · tag F0759 — failed to keep medication error rate low — isolatedEnsure medication error rates are not 5 percent or greater.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, interview and record review, the facility failed to ensure a medication error rate of less than 5%. Out of 29 opportunities observed, two errors occurred, resulting in a 6.89% medication error rate (Resident #344). The census was 205 with 140 residents in certified beds. Review of the facility Policy and Procedure for Administering Medication, dated 1/25/17 and reviewed on 9/25/18, showed: -Policy Statement: Medication shall be administered in a safe and timely manner and as prescribed. The community shall provide residents with necessary medication(s) when they leave the community temporarily; -Policy Interpretation and Implementation: -Medications must be administered in accordance with the orders, including the required time frame; -If the dosage is believed to be inappropriate or excessive for the resident, or a medication has been identified as having potential adverse consequence for the resident or is suspected of being associated with adverse consequences, the person preparing or administrating the medication shall contact the resident's physician or…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2019-06-11 · tag F0761 — failed to label and store drugs safely — isolatedEnsure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to ensure drugs and biologicals used in the facility were labeled in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable by failing to properly date and label insulin flexpens (prefilled injectable insulin) and insulin vials for six of 15 insulin pen or vial observations. The census was 205 with 140 residents in certified beds. 1. Review of the facility's storage of medication policy, dated [DATE], showed: -Policy statement: The community shall store all drugs and biologicals in a safe, secure and orderly manner; -Policy interpretation and implementation: Drug containers that have missing, incomplete, improper or incorrect labels should be returned to the pharmacy or destroyed. 2. Review of the facility Policy and Procedure for Administering Medication, dated [DATE], and reviewed on [DATE], showed: -Policy Interpretation and…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2019-06-11 · tag F0838 — failed to assess facility resources and resident needs — isolatedConduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to conduct and document a complete facility-wide assessment to determine what resources are necessary to care for the residents competently during both day-to-day operations and emergencies by not identifying a resource of agency staff used to fulfill staffing needs, address an evaluation of the facility's training program to ensure any training needs are met for all new and existing staff, individuals providing services under a contractual arrangement and volunteers, consistent with their expected roles, and include an evaluation of any contracts, memorandums of understanding including third party agreements for the provision of goods, services or equipment to the facility during both normal operations and emergencies. The census was 205 with 140 residents in certified beds. Review of the facility's Clinical Support Services Agreement, dated 3/1/11, between the facility and a spine and orthopedic surgery center, showed the facility agreed:…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2019-06-11 · tag F0842 — failed to keep accurate, complete medical records — isolatedSafeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to maintain medical records on each resident that are complete, accurately documented and readily accessible, in accordance with accepted professional standards and practices, for three of three spine or orthopedic surgery center residents followed by a contracted spine and orthopedic surgery center for post-surgical care (Residents #244, #245 and #246). The sample was 28. The census was 205 with 140 residents in certified beds. 1. Review of Resident #244's medical record, showed the resident followed by a contracted spine and orthopedic surgery center for post-surgical care: -admitted [DATE] at 9:12 P.M.; -An order dated 6/5/19, for neurological checks per shift; -An order dated 6/5/19, for vital signs per shift; -Vital signs (blood pressure, pulse, temperature, respirations, oxygen saturation and pain) documented on 6/5/19 at 9:49 P.M.; -No further vital signs documented; -No documentation of neurological checks completed; -No admitting diagnosis…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2019-06-11 · tag F0880 — failed to prevent and control infections — isolatedProvide and implement an infection prevention and control program.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to ensure staff used acceptable infection control procedures for a resident on isolation precautions for one sampled resident who was on isolation precautions for an infectious disease (Resident #111). In addition, the facility failed to maintain appropriate infection control by failing to ensure staff handled medications properly to prevent the potential spread of infection during medication administration when staff used bare hands to administer medications to one resident (Resident #124). The sample was 28. The census was 205 with 140 residents in certified beds. 1. Review of the facility's care of the resident with Clostridium Difficile infection (C-diff, a bacterial infection that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon), revised 1/29/18, showed: -Statement: Appropriate measures will be utilized to prevent and control C-diff infections. Transmission based precautions will be determined based…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2019-06-11 · tag F0925 — failed to control pests — isolatedMake sure there is a pest control program to prevent/deal with mice, insects, or other pests.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, interview and record review, the facility failed to maintain an effective pest control program to prevent gnats in resident rooms for one resident (Resident #138). The sample was 28. The census was 205 with 140 residents in certified beds. Review of Resident #138's quarterly Minimum Data set (MDS), a federally mandated assessment instrument completed by facility staff, dated 2/12/19, showed the following: -Moderate cognitive impairment; -Two person staff assistance for bed mobility, toilet use and transfers; -One person staff assistance for dressing, eating and personal hygiene; -Upper extremity impairment on both sides; -Lower extremity impairment on both sides; -Mobility, wheelchair; -Diagnoses included high blood pressure, multiple sclerosis (an autoimmune disease of the nervous system) and anemia. Observation and interview of the resident on 6/05/19 at 10:22 A.M., showed the resident in his/her room. He/she lay in his/her bed, propped upright by pillows. Two drink cups with lids and drink spouts sat on the bedside table beside him/her, both drink spouts…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
“Cited before” means this same F-tag appears on at least one other survey date in the record we hold — counting complaint investigations as well as standard surveys, with no time limit. It is our own read of the data, not CMS’s: CMS uses repeat deficiency as a formal term tied to consecutive standard surveys, and that is a narrower test than this one. A tag marked here may or may not meet it.
- Long-Term Care Ombudsman — a free, confidential advocate for the resident. They act only with the resident’s consent and work to resolve the problem. Find yours at theconsumervoice.org/get_help.
- Adult Protective Services — the state agency that investigates suspected abuse, neglect, or exploitation of a vulnerable adult. Not sure of your state’s APS number? The federal Eldercare Locator will route you: 1-800-677-1116 or eldercare.acl.gov.
- State survey agency — the regulator that licenses and inspects the home. Every state has an official nursing-home complaint line and most take complaints online; the Ombudsman or Eldercare Locator can connect you.
Fines & penalties
No federal fines in the current CMS record.
Part of a chain
This home belongs to EVERTRUE — 5 facilities. Here is how its ratings compare with the chain’s average across all its homes: See the whole chain — ratings, flags, fines and finances →
| Rating | This home | Chain avg | |
|---|---|---|---|
| Overall | 5 of 5 | 4.8 | +0.2 vs chain |
| Health inspection | 5 of 5 | 4.4 | +0.6 vs chain |
| Staffing | 4 of 5 | 4.8 | -0.8 vs chain |
| Quality measures | 5 of 5 | 4.4 | +0.6 vs chain |
The other 4 homes this chain runs (chain average 4.8★, per CMS)
A home rated well below its chain’s average can signal local problems; a chain with a low average across the board is a bigger pattern worth researching. CMS chain data under-reports private-equity and REIT ownership, so treat this as a floor, not the full picture.
Who owns this facility
| Owner / manager | Type | Role | Share | Since |
|---|---|---|---|---|
| LUTHERAN SENIOR SERVICES | Organization | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100% | since 02/01/2016 |
| MARLES, ADAM | Individual | W-2 MANAGING EMPLOYEE; CORPORATE DIRECTOR; CORPORATE OFFICER | — | since 11/01/2021 |
| SCHAEFER, RONALD | Individual | W-2 MANAGING EMPLOYEE; CORPORATE OFFICER | — | since 02/06/2023 |
| SNEED, CHADWICK | Individual | W-2 MANAGING EMPLOYEE; CORPORATE OFFICER | — | since 07/01/2020 |
| ANDERSON, DAVID | Individual | CORPORATE DIRECTOR | — | since 07/01/2019 |
| BANTLE, JULIE | Individual | CORPORATE DIRECTOR | — | since 07/01/2019 |
| BEUMER, BRENT | Individual | CORPORATE DIRECTOR | — | since 06/27/2022 |
| BROWN, DANIEL | Individual | CORPORATE DIRECTOR | — | since 04/25/2018 |
| CHRISTELL, ROY | Individual | CORPORATE DIRECTOR | — | since 04/25/2017 |
| DROLLINGER, DIANE | Individual | CORPORATE DIRECTOR | — | since 03/24/2014 |
| DUNN, JEFFREY | Individual | CORPORATE DIRECTOR | — | since 04/28/2015 |
| KUHLMANN, FREDERICK | Individual | CORPORATE DIRECTOR | — | since 04/28/2015 |
| MCCLINE, ELISE | Individual | CORPORATE DIRECTOR | — | since 07/01/2021 |
| MEADOWS, MEGAN | Individual | CORPORATE DIRECTOR | — | since 01/24/2022 |
| MUELLER, HARRY | Individual | CORPORATE DIRECTOR | — | since 04/26/2016 |
| SOMBART, LISA | Individual | CORPORATE DIRECTOR | — | since 04/25/2017 |
| SOMMER, CHRISTOPHER | Individual | CORPORATE DIRECTOR | — | since 07/01/2023 |
| TICE, PAUL | Individual | CORPORATE DIRECTOR | — | since 04/25/2017 |
| TOON, NORMAN | Individual | CORPORATE DIRECTOR | — | since 07/01/2019 |
CMS files one row per role, so the 23 rows in the source record cover these 19 parties — each is shown once here with every role it holds. Nothing is omitted.
1 organizational owner listed — a facility can be part of a larger chain. CMS ownership data is known to under-report private-equity and REIT ties; treat as a starting point.
Follow the money — this home’s finances
Where a nursing home’s revenue comes from and where it goes — including money paid to companies under the same ownership. Most consumer sites never show this; we reproduce it straight from the Medicare cost report.
This home reported $1.6M paid to related parties (affiliated landlords or management companies) in its most recent cost report.
Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2023. Facilities self-file these reports; figures are unaudited and a year or two behind. A home with no Medicare cost report on file shows no figures here.
Cost & finances
Straight from this home’s Medicare cost report (CMS, FY2023). These are its operating economics — what it costs to run per resident-day and what it collects on average across Medicare, Medicaid, and private pay — not a private-pay quote. Your out-of-pocket cost depends on payer and room type, so ask the facility directly; a higher operating cost can reflect richer staffing or a sicker population. The cost-of-care planner shows regional benchmarks by care type.
What families pay in MO
This is a Medicare- and Medicaid-certified nursing home, so it can accept Medicaid for long-term care — like nearly all U.S. nursing homes. The private-pay figures below are what families without Medicaid pay; once a resident qualifies for Medicaid, out-of-pocket cost for covered nursing-home care is typically close to $0 (almost all of their income goes to the home as their share of the cost; they keep a small personal needs allowance — for clothing, haircuts, a phone — and Medicaid pays the rest). The amount of that allowance is set by each state. Confirm Medicaid-bed availability with the home, and see the Missouri Medicaid page.
Median private-pay cost, CareScout (Genworth) 2025 Cost of Care Survey — a regional midpoint, not any single community’s rate. Private rooms and higher care levels cost more; ask for a current quote. Project your own in the cost-of-care planner.
Every figure above is reproduced from the CMS Provider Data Catalog (a public record), from the CMS extract processed 2026-08-01 — CMS provider number 265071. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2024-08-22, which can lag current conditions. Staffing hours are CMS PBJ CY2026Q1 (Jan–Mar 2026). Check this record against the government’s own page for it: this home on Medicare Care Compare ↗ — the authoritative source, and the place to confirm anything here before you act on it. How we present it →
Not a government site. Eldercare Lens is not affiliated with, endorsed by, or authorized by the Centers for Medicare & Medicaid Services (CMS), Medicare, or any government agency. The star ratings, citations, and inspection wording on this page are reproduced from the public CMS record; the plain-English summaries, tiers, and comparisons around them are ours. We do not speak for CMS, and CMS has not reviewed this page. For the official record, go to Medicare Care Compare. How we’re funded →
Are you this operator? If the record here is out of date, or misses what you have since fixed, tell us and we will look: hello@eldercarelens.com. We reproduce the public CMS record and cannot change what it says — corrections to the underlying data go through CMS and your state survey agency — but we will correct anything we have got wrong about it, and we will say so on the page.